Provider Demographics
NPI:1124598289
Name:WILSON, ARTHUR JR (CDCA)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 NORTHLAND BLVD UNIT 46442
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-7614
Mailing Address - Country:US
Mailing Address - Phone:513-225-5364
Mailing Address - Fax:
Practice Address - Street 1:670 NORTHLAND BLVD UNIT 46442
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-7614
Practice Address - Country:US
Practice Address - Phone:513-225-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)